Browsing by Author "Lin, Ting-Tse"

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Agreement Between Automated and Human Measurements of Heart Rate in Patients With Atrial Fibrillation
(2018-09-01)
Lin, Ting-Tse
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Wang, Chia-Ling
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Liao, Min-Tsun
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Lai, Chao-Lun
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分子醫學與生物工程研究所
Background: The accuracy of heart rate (HR) measurement by automated blood pressure monitors in patients with atrial fibrillation (AF) remains unclear. The authors investigate the agreement between HR measurements by 2 automated devices and human counting in patients with AF. Methods: In 47 patients with persistent AF, HR was recorded using 2 automated blood pressure monitors: Omron M5-I and Microlife BPA100 Plus. Human counting of HR by a stethoscope was used as the reference. For each method, 3 readings were made and the mean was calculated for comparison. In addition to Wilcoxon signed rank test, the correlation between HR measurements by automated devices and human counting was determined using Spearman's rank correlation coefficient (r), and the agreement between HR measurements by both devices and human counting was validated by the Bland-Altman plot and intraclass correlation coefficient (ICC). Results: Overall, we found no significant difference in HR measurements between devices and human counting (Omron vs human counting, 81.1 +/- 11.1 vs 80.2 +/- 10.8 beats per minute [bpm]; P = .21, r = 0.911; ICC, 0.954; Microlife vs human counting, 81.3 +/- 10.8 vs 80.2 +/- 10.8 bpm; P = .22, r = 0.842; ICC, 0.912). However, in patients with HR greater than 80 bpm, the HR measured by the Microlife device was significantly higher than that measured by human counting (91.1 +/- 5.2 vs 87.1 +/- 8.6 bpm, P = .034). Conclusion: There was a high agreement between HR measurements by 2 automated devices and human counting, but the Microlife device may overestimate HR in AF patients with HR greater than 80 bpm.
Anti-Hyperglycemic Agents and New-Onset Acute Myocardial Infarction in Diabetic Patients with End-Stage Renal Disease Undergoing Dialysis
(2016-08-11)
Lin, Ting-Tse
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Wu, Chih-Chen
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Yang, Yao-Hsu
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Lin, Lian-Yu
;
Lin, Jiunn-Lee
Background Diabetes and chronic kidney disease (CKD) are a high-stakes combination for cardiovascular disease. Patients with decreased kidney function and end-stage renal disease ( ESRD) have increased risk of hypoglycemia when attaining better glycemic control, leading to higher risk of myocardial infarction (MI). For these patients, which kinds of anti-hyperglycemic agents would be associated with higher risk of MI is not clear. Methods We identified patients from a nation-wide database called Registry for Catastrophic Illness, which encompassed almost 100% of the patients receiving dialysis therapy in Taiwan from 1995 to 2008. Patients with diabetes and ESRD were selected as the study cohort. Propensity score adjustment and Cox's proportional hazards regression model were used to estimate the hazard ratios (HRs) for new-onset MI. Results Among 15,161 patients, 39% received insulin, 40% received sulfonylureas, 18% received meglitinides and 3% received thiazolidinedione (TZD). After a median follow-up of 1,357 days, the incidence of MI was significant increase in patients taking sulfonylureas (HR =1.523, 95% confidence interval [CI]=1.331-1.744), meglitinides ( HR=1.251, 95% CI=1.048-1.494) and TZD (HR=1.515, 95% CI=1.071-2.145) by using patients receiving insulin therapy as the reference group. The risk of MI remains higher in other three groups in subgroup analyses. Conclusions In conclusion, among diabetic patients with ESRD undergoing dialysis, the use of sulfonylureas, meglitinides and TZD are associated with higher risk of new-onset MI as compared with insulin.
Comparison of Home and Ambulatory Blood Pressure Measurements in Association With Preclinical Hypertensive Cardiovascular Damage
(2019-03-01)
Lin, Ting-Tse
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Juang, Jimmy Jyh-Ming
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Lee, Jen-Kuang
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Tsai, Chia-Ti
;
Chen, Chen-Huan
Objective: To evaluate whether home or ambulatory blood pressure (BP) monitoring was associated with preclinical hypertensive cardiovascular target organ damage (TOD). Methods: We enrolled participants with prehypertension and stage 1 hypertension from 11 medical centers within the Taiwan hypertension-associated cardiac disease consortium. Recordings of clinical BP measurement, ambulatory BP monitoring for 24 hours, and home BP monitoring during morning and evening were made. The measured parameters of target organ damage included left ventricular mass index (LVMI), left atrial volume index (LAVI), and carotid-femoral pulse wave velocity (PWV). Results: Data were collected from 561 study participants (mean age, 65.0 +/- 10.8 years; men, 61.3%). Morning and evening home BP values were slightly higher than the daytime and nighttime ABP values (difference for systolic morning-daytime/evening-nighttime, 7.3 +/- 14.2/11.3 +/- 18.5 mm Hg, P <.001; for diastolic, 5.4 +/- 9.4/ 7.3 +/- 12.1, P <.001). Daytime ambulatory (r = 0.114), nighttime ambulatory (r = 0.130), morning home (r = 0.310), and evening home (r = 0.220) systolic BPs (SBPs) were all associated with LVMI (all P <.05). The correlation coefficient was significantly greater for the relationship between daytime home SBP and LVMI than for the relationship between ambulatory SBP and LVMI (P <.01). The goodness of fit of the association between SBP and LVMI improved by adding home daytime SBP to the other SBPs (P <.001). Similar findings were observed for LAVI, but not for PWV. Conclusion: These findings indicate that morning SBP assessed by home monitoring appears to be a better predictor than other BP measures to determine preclinical hypertensive cardiovascular damage in patients with early-stage hypertension.
Long-term Prognostic Value of Estimated Plasma Volume in Heart Failure with Preserved Ejection Fraction
(2019-10-07)
Huang, Chen-Yu
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Lin, Ting-Tse
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Wu, Yi-Fan
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Chiang, Fu-Tien
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Wu, Cho-Kai
Plasma volume, estimated by several indirect methods, has been viewed as a biological surrogate for intravascular fluid status. The clinical implication of estimated plasma volume status (ePVS) for long term outcomes in heart failure with preserved ejection fraction (HFpEF) remains unclear. We investigate the prognostic value of ePVS calculated by Strauss formula and its association with cardiovascular events and mortality in a prospective HFpEF cohort. There were 449 individuals met the inclusion criteria of our cohort. Estimated plasma volume variation (Delta ePVS) and its instantaneous derivatives were calculated by the Strauss formula. Our study endpoints were events of heart failure hospitalization and mortality. Kaplan-Meier estimates and Cox regression analysis were applied to determine the power of Delta ePVS and baseline ePVS in predicting long term cardiovascular outcomes. Both baseline ePVS and Delta ePVS were independent predictors of heart failure hospitalization and mortality. Kaplan-Meier estimates of these outcomes stratified by optimal cut-off value showed that HFpEF individuals with higher baseline ePVS and Delta ePVS were associated with elevated risk of composite endpoint of heart failure hospitalization and mortality. This study demonstrated the prognostic value of a novel biological surrogate, instantaneous derivatives ePVS, in predicting long term cardiovascular outcomes in HFpEF population. Monitoring instantaneous plasma volume may assist in identifying patients at high risk for future cardiovascular events. Further prospective studies validating the role of ePVS in predicting long-term prognosis in patients with HFpEF are warranted.
Myocardial adipose deposition and the development of heart failure with preserved ejection fraction
(1970-01-01)
Wu, Cho-Kai
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Lee, Jen-Kuang
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Hsu, Jung-Chi
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Su, Mao-Yuan M.
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Wu, Yi-Fan
Aims It has been proposed that an increase of myocardial adiposity is related to left ventricular (LV) diastolic dysfunction. The specific roles of myocardial steatosis including epicardial fat and intramyocardial fat for diastolic function are unknown in those patients suffering heart failure (HF) with reduced (HFrEF) or preserved ejection fraction (HFpEF). This study aims to determine the complex relationship between myocardial adiposity in patients with HFrEF or HFpEF. Methods and results Using cardiac magnetic resonance imaging (CMRI), myocardial steatosis was measured in 305 subjects (34 patients with HFrEF, 163 with HFpEF, and 108 non-HF controls). We also evaluated cardiac structure and diastolic and systolic function by echocardiography and CMRI. Patients with HFpEF had significantly more intramyocardial fat than HFrEF patients or non-HF controls [intramyocardial fat content (%), 1.56 (1.26, 1.89) vs. 0.75 (0.50, 0.87) and 1.0 (0.79, 1.15), P < 0.05]. Intramyocardial fat amount (%) was higher in HFpEF women than in men [1.91% (1.17%, 2.32%) vs. 1.22 (0.87%, 2.02%), P = 0.01]. When estimated by CMRI (left ventricular peak filling rate), echocardiographic E/e ' level, or left atrial volume index, intramyocardial fat correlated with LV diastolic dysfunction parameters in HFpEF patients, and this was independent of age, co-morbidities, body mass index, gender, and myocardial fibrosis (standardized coefficient: beta = -0.34, P = 0.03; beta = 0.29, P = 0.025; and beta = 0.25, P = 0.02, respectively). Conclusions Patients with HFpEF had significantly more intramyocardial fat than HFrEF patients or non-HF controls. Independent of risk factors or gender, intramyocardial fat correlated with LV diastolic dysfunction parameters in HFpEF patients.
Primary prevention of myocardial infarction with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in hypertensive patients with rheumatoid arthritis - A nationwide cohort study
(2017-12-07)
Lin, Ting-Tse
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Wu, Cho-Kai
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Liao, Min-Tsun
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Yang, Yao-Hsu
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Chen, Pau-Chung
Background Rheumatoid arthritis (RA) is regarded as a high risk factor for myocardial infarction. Hypertension is a major modifiable risk factor contributing to increased risk of myocardial infarction (MI). Dual blood pressure (BP)-lowering and anti-inflammatory effect of renin-angiotensinsystem (RAS) inhibitors may possess protective effect from MI in RA population. However, treatment of hypertension with RAS inhibitors and MI in RA population remains unclear. Methods We investigated whether RAS blockade could decrease risk of incident MI in hypertensive patients with RA. We identified patients with RA and hypertension from the Registry for Catastrophic Illness, a nation-wide database encompassing almost all of the RA patients in Taiwan from 1995 to 2008. The primary endpoint was MI and the median duration of follow up was 2,986 days. Propensity score weighting and Cox proportional hazards regression models were used to estimate hazard ratios for MI. Results Among 27,335 subjects, 9.9% received angiotensin-converting enzyme inhibitors (ACEIs), 25.9% received angiotensin II receptor blockers (ARBs) and 20.0% received ACEIs or ARBs alternatively. The incidence of MI significantly decreased in patients treated with ACEIs (hazard ratio 0.707; 95% confidence interval 0.595 - 0.840), ARBs (0.641; 0.550 - 0.747) and ACEIs/ARBs (0.631; 0.539 - 0.739). The protective effect of ACEI or ARB therapy was significantly better in patients taking longer duration. The effect remained robust in subgroup analyses. Conclusions Therapy of ACEIs or ARBs is associated with a lower risk of MI among patients with RA. Hence, hypertension in patients with RA could comprise a compelling indication for RAS inhibitors.
Proarrhythmic risk and determinants of cardiac autonomic dysfunction in collagen-induced arthritis rats
(2016-11-29)
Lin, Ting-Tse
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Sung, Yen-Ling
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Wu, Chih-En
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Zhang, Hong
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Liu, Yen-Bin
Backgrounds: Patients with rheumatoid arthritis (RA) have increased risk of sudden cardiac death (SCD), which is two-fold higher than general population. The driving cause of SCD was considered due to lift-threatening arrhythmia where systemic inflammation acts as the pathophysiological basis linking RA to autonomicdysfunction. Methods: To assess the sympathetic over-activity of "inflammatory reflex", we measured heart rate variability (HRV) in a rat collagen-induced arthritis (CIA) model, whose arthritis is induced in Lewis rats by intradermal injection of emulsion of type II collagen. Single-lead electrocardiogram (ECG) was recorded for 30 min every two days. Time and frequency-domain parameters, detrended fluctuation analysis (DFA), deceleration (DC) and acceleration capacity (AC) were analyzed. Results: Compared with 9 control rats, many of HRV parameters of 9 CIA rats revealed significant different. At the beginning of arthritis, LF/HF was significant higher than controls (1st week: 2.41 +/- 0.7 vs. 1.76 +/- 0.6, p < 0.05; 2nd week: 2.24 +/- 0.5 vs. 1.58 +/- 0.5, p < 0.05) indicating intensive inflammatory reflex at the initial phase of inflammation but no significant difference was observed in the following recover phase. The similar trend of DFA parameters was noted. However, the DC appeared progressive lower despite of no significant increase of the LF/HF compared with controls since 4th week. Conclusions: We observed sympathetic over-activation of inflammatory reflex during early stage of arthritis in CIA rats. The ongoing decline of DC indicated advanced cardiac autonomic dysfunction regardless of remission of acute arthritis.
Proarrhythmic risk and determinants of cardiac autonomic dysfunction in collagen-induced arthritis rats
(2016-11-29)
Lin, Ting-Tse
;
Sung, Yen-Ling
;
Wu, Chih-En
;
Zhang, Hong
;
Liu, Yen-Bin
Backgrounds: Patients with rheumatoid arthritis (RA) have increased risk of sudden cardiac death (SCD), which is two-fold higher than general population. The driving cause of SCD was considered due to lift-threatening arrhythmia where systemic inflammation acts as the pathophysiological basis linking RA to autonomicdysfunction. Methods: To assess the sympathetic over-activity of "inflammatory reflex", we measured heart rate variability (HRV) in a rat collagen-induced arthritis (CIA) model, whose arthritis is induced in Lewis rats by intradermal injection of emulsion of type II collagen. Single-lead electrocardiogram (ECG) was recorded for 30 min every two days. Time and frequency-domain parameters, detrended fluctuation analysis (DFA), deceleration (DC) and acceleration capacity (AC) were analyzed. Results: Compared with 9 control rats, many of HRV parameters of 9 CIA rats revealed significant different. At the beginning of arthritis, LF/HF was significant higher than controls (1st week: 2.41 +/- 0.7 vs. 1.76 +/- 0.6, p < 0.05; 2nd week: 2.24 +/- 0.5 vs. 1.58 +/- 0.5, p < 0.05) indicating intensive inflammatory reflex at the initial phase of inflammation but no significant difference was observed in the following recover phase. The similar trend of DFA parameters was noted. However, the DC appeared progressive lower despite of no significant increase of the LF/HF compared with controls since 4th week. Conclusions: We observed sympathetic over-activation of inflammatory reflex during early stage of arthritis in CIA rats. The ongoing decline of DC indicated advanced cardiac autonomic dysfunction regardless of remission of acute arthritis.
Risk of ischemic stroke in patients with hypertrophic cardiomyopathy in the absence of atrial fibrillation - a nationwide cohort study
(2019-12-15)
Lin, Ting-Tse
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Sung, Yen-Ling
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Ko, Tsung-Yu
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Lee, Chih-Kuo
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Lin, Lian-Yu
Ischemic stroke (IS) is a catastrophic complication of hypertrophic cardiomyopathy (HCM) with aging. We investigated the incidence of IS in HCM patients without atrial fibrillation (AF) and compared the relative risk of IS with matched general population with AF. This study identified 17,371 HCM patients without AF and utilized propensity-score-matching to identify one-to-one matched control of general population with AF receiving oral anti-coagulants (OACs). During a median follow-up of 7.3 years, 847 (4.9%) subjects experienced IS with the incidence of 0.589/100 person-years. The corresponding matched controls experienced 788 (4.5%) events with the incidence of 0.494/100 person-years. Compared with control, HCM patients had similar risk of IS (Hazard ratios [HRs] 0.965, 95% confidence interval [CI] 0.854-1.091). HCM patients with age above 65 years had a significantly increased risk of IS (age 65-74 years, HR 1.278, 95% CI 1.070-1.335; age >= 75 years, HR 1.757, 95% CI 1.435-2.152). Stratified by CHA(2)DS(2)-VASc score, HCM subjects with score 0, 1 and 2 had significantly increased risk of IS than control while those with score >= 2 had similar risk as control. Compared with general population with AF, HCM patients without AF had similar risk of IS, suggesting OACs might be necessary in HCM patient without AF.
Single and dual antiplatelet therapy in elderly patients of medically managed myocardial infarction
(2018-04-05)
Lin, Ting-Tse
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Lai, Hsiu-Yun
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Chan, K. Arnold
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Yang, Yen-Yun
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Lai, Chao-Lun
Backgrounds: To examine the comparative effectiveness between dual and single antiplatelet therapies in real-world, medically managed elderly patients with acute myocardial infarction (AMI). Methods: This retrospective study identified very elderly (> 85 years) patients, who were medically managed, with their first AMI from the Taiwan National Health Insurance claims database from 2007 to 2010. Patients were classified as dual antiplatelet therapy (DAPT) group, aspirin only group and clopidogrel only group. Study outcomes included all-cause death, cardiovascular death and gastrointestinal bleeding. Treating DAPT group as the reference, we employed a multivariable Cox regression model to compare the relative risks of outcomes between 3 groups using pairwise comparison approach. Results: Among 1469 patients with incident ST-elevation myocardial infarction (STEMI, 14%) or non-STEMI (86%), 390 patients were prescribed DAPT, 549 aspirin only, and 530 clopidogrel only. After 9 months of follow-up, aspirin only group had similar risks of all-cause death (adjusted HR 1.21, 95% CI 0.77-1.89, p = 0.41), cardiovascular death (adjusted HR 1.16, 95% CI 0.66-2.04, p = 0.60) and gastrointestinal bleeding (adjusted HR 1.66, 95% CI 0.77-3.57, p = 0.20) in comparison with DAPT group. Clopidogrel users had a higher risk of all-cause death (adjusted HR 1.50, 95% CI 1.00-2.25, p = 0.049) but similar risks of cardiovascular death and gastrointestinal bleeding when compared with DAPT. Conclusions: Among very elderly patients who were medically managed after AMI, single antiplatelet therapy had comparable protective effect as DAPT. But clopidogrel only strategy was associated with a higher risk of all-cause death.
Use of calcium channel blockers and myocardial infarction in hypertensive patients with rheumatoid arthritis - A nationwide cohort study
(2020-01-01)
Lin, Ting-Tse
;
Ko, Tsung-Yu
;
Lin, Lian-Yu
;
Wu, Cho-Kai
;
生物科技學系
Background/ purpose: Rheumatoid arthritis (RA) should be regarded as a high risk factor for myocardial infarction (MI). In addition to anti-hypertensive effect, calcium channel blockers (CCBs) were frequently used as anti-angina drugs in patients with MI. However, the association between CCBs and MI in RA remains unclear. We investigated whether CCBs could decrease incidence of myocardial infarction in patients with hypertension and RA. Methods: We identified patients from the Registry for Catastrophic Illness, a nation-wide database encompassing almost all of the RA patients in Taiwan from 1995 to 2008. The primary endpoint was MI and the median duration of follow up was 3,050 days. Propensity score matching and Cox proportional hazards regression models were used to estimate hazard ratios for MI. Results: Among 27,844 patients with hypertension, 17,317 (61.5%) subjects received CCBs (mean ageZ58.8 years, 72.1% female). The incidence of MI significantly decreased in patients treated with CCBs (hazard ratio [HR] 0.560; 95% confidence interval [CI] 0.494-0.634). After propensity match, subjects receiving CCBs had significantly lower risk of MI (HR 0.637, 95% CI 0.549-0.740). The protective effect of CCBs therapy was significantly better in patients taking longer duration. Of note, the effect remained robust in subgroup analyses, including dihydropyridine CCBs (HR 0.550; 95% CI 0.466-0.650) and non-dihydropyridine CCBs (HR 0.674, 95% CI 0.588-0.773). Conclusion: Therapy of CCBs is associated with a lower risk of MI among hypertensive patients with RA. Hence, the prescription of CCBs may be a compelling indication of BP lowering in RA population. Copyright (C) 2019, Formosan Medical Association. Published by Elsevier Taiwan LLC.